P.O Box 15118
325 South Belmont Street
York, Pennsylvania 17405

Understanding Your Hospital Bill
During or after your stay or visit, you may have questions about the bill you receive from UPMC Pinnacle Memorial and from other medical professionals who provided care during your hospital visit.
The Department of Patient Accounting makes every effort to keep our Hospital billing process as "hassle-free" as possible. Still, we know the various insurance forms, physicians' bills and hospital bills may be complex and confusing. Consequently, we provide this information to answer some of the commonly asked questions.
Commonly Asked Questions
Who do I contact to find out how much my hospitalization or test will cost?
You may contact our customer service line at 717-849-5432 for an estimate on simple outpatient procedures. (Information for outpatient surgery and inpatient stays is not available due to the complicated nature of these services.) Charges quoted will be based on information you provide from your physician. This quote is an estimate only and does not include charges for physician fees associated with the service.
When is payment of my bill due?
If you do not have insurance, we request full payment of the balance within 14 days of receiving your bill unless alternate payment arrangements have been made.
How do I make financial arrangements on my bill?
The financial policy of UPMC Pinnacle Memorial is designed to allow anyone in need of critical care and/or emergency health care to receive such care, regardless of financial status or ability to pay. However, we ask for your cooperation in fulfilling your financial obligation to UPMC Pinnacle Memorial by paying your bill promptly or contacting your insurance carrier regarding payment.
UPMC Pinnacle Memorial accepts cash, checks and a variety of credit cards. If full payment is not possible, you may meet the criteria for an installment plan or financial hardship program. You will be asked to disclose certain financial information in order to be eligible. Contact the Patient Financial Services (PFS) office at 717-849-5420 for more information. Arrangements must be made within 30 days of receipt of your bill.
We also have on-site financial counselors available to assist you with your financial options prior to admission or discharge. Contact the counselors at 717-849-5438 or 717-849-5422.
We also offer on-line credit care payment and check processing. These options may be accessed through this website.
Will the hospital bill my insurance?
The Billing Office bills both primary and secondary insurance carriers. There are a variety of plans and networks in existence so it is important to furnish complete and accurate insurance information in order to expedite prompt payment. Always carry your insurance card(s) and identification with you on each visit.
Will my insurance pay for everything?
There are many different types of insurance plans with a variety of coverage options. Typical patient charges include co-pays and deductibles. These patient charges are applicable even though the Hospital may have a contract with your insurance carrier.
How do I know the insurance carrier has received a bill from the Hospital?
If your carrier does not process the claim within 30 to 45 days, you will receive an invoice from the Hospital. We suggest you contact your insurance carrier if you have any questions regarding payment of the bill. Encourage them to pay the claim promptly on your behalf. Ultimately, you are responsible for those charges unpaid by your insurance carrier.
How will I know the status of my account?
You, or the responsible guarantor, will receive monthly statements indicating the status of your account, including any credits for payments you have made, contractual adjustments and/or insurance payments. Please be aware that each time you receive services from the Hospital, a separate account is created. It is possible to have several accounts, with different account numbers, open at the same time.
If I have a concern with my bill, who do I call?
You may contact the Customer Service Representative at 717-849-5432 between the hours of 7:30 a.m. and 4:30 p.m, Monday through Friday, or visit the office personally between the same hours. The PFS office is located on the first floor right off the lobby area.
Helpful Tip
Keeping track of the bills sent by various health care professionals and facilities, as well as the information sent to you by your insurance carrier, can be challenging. We suggest you keep these records in a separate file, noting the dates of service and payments made for those services. Keeping records in one place will be helpful in resolving billing questions and may also come in handy when it comes time to file your income tax return.
Physician Bills
In addition to the Hospital’s bill, you may receive separate bills from your personal physician, radiologist, anesthesiologist, emergency room physician and other consultants or specialists that your attending physician chooses to involve in your case. They will bill you directly for their services because they are in private practice — they are not employed by UPMC Pinnacle Memorial.
The Hospital cannot control which insurance plans are accepted by the physicians who provide services at UPMC Pinnacle Memorial. Therefore, you should discuss with your personal physician, whether he/she can include in your care only physicians who accept your insurance plans. Otherwise, you may incur additional co-insurance expenses.
Understanding Health Insurance
Terminology used to describe various aspects of a hospital bill can be confusing. Here are some terms used frequently by UPMC Pinnacle Memorial and most health insurance carriers:
The amount you are required to pay for medical care after you have met your deductible. This rate is usually expressed as a percentage of covered charges, i.e. 20%.
Coordination of Benefits (COB):
COB eliminates the duplication of benefits when you are covered under more than one group plan. Benefits under the two plans usually are limited to no more than 100 percent of the billed charges. Many insurance companies will not process claims until they have COB information on file. Should your carrier request this information, please respond immediately.
Co-payment (Co-pays):
Flat fee you pay every time you receive service. Most insurance companies have co-pays for physician visits and emergency room visits.
Contractual Adjustments:
The difference between hospital charges and what the hospital is contractually obligated to accept as payment from the insurance company.
The amount of money you must pay each year to cover your medical care expenses before your insurance policy starts to pay.
Explanation of Benefits (EOB):
A form sent to you by your insurance carrier. It explains the amount of total hospital charges covered by your policy, the amount of payment made and to whom, and any deductibles or co-insurance.
Individual financially responsible for payment of an account.
Health Maintenance Organization (HMO):
Prepaid health plans. You pay a monthly premium and the HMO covers the cost of your physician visits, hospital services, etc. You must use the physicians and hospitals designated by the HMO.
Inpatient (IP):
This refers to charges relating to an inpatient (or in hospital) admission.
Medicare Advantage Plan:
A replacement plan for traditional Medicare.
Medicare Carrier:
The company that processes Part B physician claims. HGS Administrators is the carrier in the Greater York area.
Medicare Intermediary:
The insurance company the federal government contracts with to administer the Medicare Program. Wisconsin Physician Services (WPS) is the company that is assigned to UPMC Pinnacle Memorial.
Outpatient (OP):
This refers to charges relating to outpatient testing and/or outpatient surgery.
Preferred Provider Organization (PPO):
A combination of traditional fee-for-service insurance and an HMO. When you use the physicians and hospitals that are part of the PPO network, your medical and hospital bills are covered. However, you have the option of using physicians outside the network, but at an additional cost to you.
Pre-existing Condition:
Health condition that existed before the date your insurance became effective. Many insurance plans will not cover care related to pre-existing conditions. Some will cover them only after a waiting period.
Primary Care Physician (PCP):
Family physician who monitors your health and diagnoses and treats any conditions or illnesses. Your PCP may refer you to a specialist if another level of care is needed. If you have an HMO, your PCP must authorize all services, including ER services.
Reasonable and Customary:
A fee some insurance carriers pay for a particular service. If your physician or hospital charges more than the reasonable and customary amount, you may be responsible for the difference.
Universal Billing Form (UB04):
Standard billing form required by Medicare and most insurance carriers to summarize a patient’s hospital charges.